HomeMy WebLinkAbout08-22-12•_•••~ RE 15 0 5 61014 3
V~1500 EX (01-10) ~j`
PA Department of Revenue Pennsylvania OFFICIAL USE ONLY
Bureau of Individual Taxes UEPARTMENTOFREVENUE County Code Year
PO 60X.280601 File Number
Harrisburg, PA 17128-0601 INHERITANCE TAX RETURN 21 11
ENTER DECEDENT INFORMATION BELOW RESIDENT DECEDENT 0994
Social Security Number Date of Death
18 8 3 6 63 5 6 Date of Birth
08 27 2011 10 19 1953
Decedent's Last Name
1`zYERS Suffix Decedent's First Name
MI
PEGGY
(If Applicable) Enter Surviving Spouse's Info
rmation Below Y
Spouse's Last Name
Suffix Spouse's First Name
MI
Spouse's Social Security Number
THIS RETURN MUST BE FILED IN DUPLICAT
E WITH THE
REGISTER OF WILLS
FILL INAPPROPRIATE OVALS BELOW
XD 1. Original Return ~ 2. Supplemental Return
Remaind
3
R
.
er
eturn (date of death
4. Limited Estate
4a. Future Interest Compromise
(date of death after 12
12
8 prior to 12-13-82)
~ 5
F
d
-
-
2) .
e
eral Estate Tax Return Required
g Decedent Died Testate
(Attach Copy of Will) ^ ~ Decedent Maint fined a Living Tr
(Attach Co
of~r ust 0
py
rust) 8. Total Number of Safe Deposit Bo
xes
9. Litigation Proceeds Received ~ 1 p Spousal PgvertYY Credit (date of death
between 1Z-31 91 and t-1-95) ~ 11.EIeCtlon to tax under See. 9113(A)
(Attach Sch. O)
CORRESPONDENT -THIS SECTION MUST BE COMPLETED. ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATION SHOULD BE DIRECTED TO:
Name
JOHN S DAVIDSON Daytime Telephone Number
717 533 5101
First line of address
320 WEST CHOCOLATE AVE
Second line of address
PO BOX 437
City or Post Office
HERSHEY
Correspondent's a-mail address:
REGISTER OS USE ONLY ~
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DAT~ILED ~ ~ ~ f'r-1
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State 21P Code ~
~'A 17033 ~~
~~ per)ury, I declare that I have examined this return, including accompanying schedules and statements, and to the best of my knowledge and belief,
and complete. Declaration of preparer other than the personal representative is based on all information of which preparer has any knowledge.
E- R~$ON RESPONSIBLE FOR FILING RETURN
Kristen Stoner
SIGNATURE OF
1
John S. Davidson
320 West Chocolate Ave.
L 1505610143
PA 17033
DATE
r2
Side 1
1505610143 J ~~
15.05610243
REV-1500 EX
Decedent's Name: nnyerS
Peggy Y Decedent's Social Security Number
,
RECAPITULATION 188 36 6356
1. Real Estate (Schedule A) ..........................
..............................................
........
....... 1.
2. Stocks and Bonds (Schedule B) .......................
............................................... ....... 2.
3,484.80
3. Closely Held Corporation, Partnership or Sole-Proprietorship (Schedule C)... ...... 3.
4. Mortgages & Notes Receivable (Schedule D) .........
....................................
.....
...... 4.
5. Cash, Bank Deposits & Miscellaneous Personal Property (Schedule E)
.......... ..... 5.
25,915.17
6. Jointly Owned Property (Schedule F) ^ Separate Billing Requested
........
7. Inter-Vivos Transfers & Miscellaneous t~nq Probate Property
(Schedule G) .... 6.
Separate Billing Requested........ .... 7
8. Total Gross Assets (total Lines 1-7) .
57,596.57
...........................................
.....................
..... 8.
86, 996.54
9. Funeral Expenses & Administrative Costs (Schedule H) .
.............
.....................
.... 9.
10 , 92 9.42
10. Debts of Decedent, Mortgage Liabilities, & Liens (Schedule I) ......... 10
.................. ...
.
28,057.04
11. Total Deductions (total Lines 9 & 10) .........................
....................................... ...
11.
38, 986.46
12. Net Value of Estate (Line 8 minus Line 11) ..................
.............. .
......................
13. Charitable and Governmental Bequests/Sec 9113 Trusts for which
... 12.
4 8 , 010.0 8
an election to tax has not been made (Schedule J) ..
........................................... .. 13.
14. Net Value Subject to Tax (Line 12 minus Line 13)
.....................................
........
.. 14.
4 8 , 010.0 8
TAX COMPUTATION -SEE INSTRUCTIONS FOR APPLICABLE RATES
15. Amount of Line 14 taxable
at the spousal tax rate, or
transfers under Sec. 9116
(a)(1.2) X .00 15. ~
~ ~
16. Amount of Line 14 taxable .
at lineal rate X .045 48 , 010.08
17. Amount of Line 14 taxable 16. 2 ,160.45
at sibling rate X .12 0.00 17.
00
0
18. Amount of Line 14 taxable .
at collateral rate X .15 0. 0 0 18. 0. 0 0
19. Tax Due .................................................................................................................. 19. 2 , 160.45
20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT. ^
Side 2
1505610243
1505610243
REV-1500 EX Page 3
Decedent's Complete Address:
DECEDENT'S NAME
Myers, Pe99Y Y
STREET ADDRESS
1100 Crandon Way
CITY
Mechanicsburg
STATE ZIP
PA ~ 17050
Tax Payments and Credits:
1. Tax Due (Page 2, Line 19)
2. Credits/Payments
A. Prior Payments
B. Discount
0.00
(1) 2,160.45
Total Credits (A + g) (2) 0.00
3. Interest
4. If Line 2 is greater than Line 1 + Line 3, enter the difference. This is the OVERPAYMENT.
Check box on Page 2 Line 20 to request a refund
5. If Line 1 + Line 3 is greater than Line 2, enter the difference. This is the TAX DUE.
Make Check Payable to: REGISTER OF
AGENT.
(3)
(4)
(5) 2,160.45
PLEASE ANSWER THE FOLLOWING QUESTIONS BY PLACING AN "X" IN THE APPROPRIATE BLOCKS
1. Did decedent make a transfer and:
a. retain the use or income of the property transferred :.......................................................................... Yes No
b. retain the right to designate who shall use the property transferred or its income :.................................. ~ O
c. retain a reversionary interest; or ............................................................................................................... ^ ^
d. receive the promise for life of either payments, benefits or care?............ ^
................................................
If death occurred after December 12, 1982, did decedent transfer property within one year of death without ^
receiving adequate consideration? .................................................................................................................... ^
3. Did decedent own an "in trust for" or payable upon death bank account or security at his or her death?....... x
4. Did decedent own an Individual Retirement Account, annuity, or other non-probate property which ^ ^
contains a beneficiary designation? ............... ^ ^
.......................................................................
IF THE ANSWER TO ANY OF THE ABOVE QUESTIONS IS YES, YOU MUST COMPLETE SCHEDULE G AND FILE IT AS PART OF THE RETURN.
For dates of death on or after July 1, 1994 and before Jan. 1, 1995, the tax rate imposed on the net value of transfers to or for the use of the surviving
spouse is 3 percent [72 P.S. §9116 (a) (1.1) (i)].
For dates of death on or after January 1, 1995, the tax rate imposed on the net value of transfers to or for the use of the surviving spouse is 0 percent
[72 P.S. §9116 (a) (1.1) (ii)]. The statute does not exempt a transfer to a surviving spouse from tax, and the statutory requirements for disclosure of
assets and filing a tax return are still applicable even if the surviving spouse is the only beneficiary.
For dates of death on or after July 1, 2000:
• The tax rate imposed on the net value of transfers from a deceased child 21 years of age or younger at death to or for the use of a natural parent, an
adoptive parent, or a stepparent of the child is 0 percent [72 P.S. §9116 (a) (1.2)].
. The tax rate imposed on the net value of transfers to or for the use of the decedent's lineal beneficiaries is 4.5 percent, except as noted in
72 P.S. §9116 1.2) [72 P.S. §9116 (a) (1)].
. The tax rate imposed on the net value of transfers to or for the use of the decedent's siblings is 12 percent [72 P.S. §9116 (a) (1.3)]. q
sibling is defined under Section 9102, as an individual who has at least one parent in common with the decedent, whether by blood or adoption.
File Number 21-11-0994
SCHEDULE B
STOCKS & BONDS
Rev-1503 EX+ (6-98)
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
Myers, Peggy Y
FILE NUMBER
21_a~_nocw
All property jointly-owned with right of survivorship must be disclosed on Schedule F.
ITEM CUSIP
NUMBER NUMBER DESCRIPTION
48 shares of ExxonAAobil -common stock
TOTAL (Also enter on Line 2, Recapitulation)
(If more space is needed, additional pages of the same size)
Copyright (c) 2002 form software only The Lackner Group, Inc.
UNIT VALUE
72.60
VALUE AT DATE
OF DEATH
3,484.80
3,484.80
Form PA-1500 Schedule B (Rev. 6-98)
Rev-1508 EX+ (6-98)
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE E
CASH, BANK DEPOSITS, & MISC.
PERSONAL PROPERTY
ESTATE OF
M
Y
FILE NUMBER
21-11-0994
Include the proceeds of litigation and the date the proceeds were received by the estate.
All property jointly-owned with the right of survivorship must be disclosed on schedule F.
ITEM
NUMBER DESCRIPTION
1 PSECU -credit union account regular shares
2 PSECU -credit union checking account
3 Comcast -account refund
VALUE AT DATE
OF DEATH
25,383.54
491.26
40.37
TOTAL (Also enter on Line 5, Recapitulation) I 25,915.17
(If more space is needed, additional pages of the same size)
Copyright (c) 2002 form software only The Lackner Group, Inc.
Form PA-1500 Schedule E (Rev. 6-98)
Rev-1510 EX+ (6-98)
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE G
INTER-VIVOS TRANSFERS &
MISC. NON-PROBATE PROPERTY
~~t~-tcvr
M ers, Pe Y FILE NUMBER
21-11-0994
This schedule must be completed and filed if the answer to any of questions 1 through 4 on the reverse side of the REV-1500 COVER SHEET is yes.
ITEM DESCRIPTION OF PROPERTY
NUMBER INCLUDE NAME OF TRANSFEREE THEIR RELATIONSHIP TO DECEDENT AND DATE OF DEATH ~ OF DecD's
THE DATE OF TRANSFER. ATTACK A COPY OF THE DEED FOR REAL ESTATE. VALUE OF ASSET INTEREST
1 Wells Fargo Advisors Funds Roth IRA -Enterprise Inv. 27,000.88
SENTX payable to decedent's children
2 I Wells Fargo Advisors Funds Roth IRA -Opportunity ~ 8,595.69
Inv. SOPFX payable to decedent's children
3 I Cash -Transferred to decedent's children by deceden~ 25.000.00 1100.000% I 3,000.00
within one year prior to death II
TOTAL (Also enter on Line 7, Recapitulation)
(If more space is needed, additional pages of the same size)
Copyright (c) 2002 form software only The Lackner Group, Inc.
TAXABLE
VALUE
27,000.88
8,595.69
22,000.00
57,596.57
Form PA-1500 Schedule G (Rev. 6-98)
REV-1151 EX+ (10-06)
SCHEDULE H
COMINHERITpENTEDECEDEENTRNANIA FUNERAL EXPENSES &
S3 DD ADMINISTRATIVE COSTS
ESTATE OF
M errs, Pe Y FILE NUMBER
21-11-0994
Debts of decedent must be reported on Schedule I.
ITEM
NUMBER DESCRIPTION AMOUNT
A. FUNERAL EXPENSES:
See continuation schedule(s) attached
B. ADMINISTRATIVE COSTS:
1. Personal Representative's Commissions
Name of Personal Representative(s)
Street Address
City State
Zip
Year(s) Commission paid
2. Attorney's Fees Yost 8c Davidson
3. Family Exemption: (If decedent's address is not the same as claimant's, attach explanation)
Claimant
Street Address
City State Zip
Relationship of Claimant to Decedent
4. Probate Fees
5. Accountant's Fees
6. Tax Return Preparer's Fees
7. Other Administrative Costs
7,279.92
3,500.00
149.50
TOTAL (Also enter on line 9, Recapitulation) I 10 929 42
Copyright (c) 2009 form software only The Lackner Group, Inc.
Form PA-1500 Schedule H (Rev. 10-06)
Rev-1512 E7(+ (12-08)
SCHEDULE 1
DEBTS OF DECEDENT,
MORTGAGE LIABILITIES, & LIENS
COMMON WEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
M ers, Pe Y FILE NUMBER
21-11-0994
Report debts incurred by the decedent prior to death that remained unpaid at the date of death, including unreimbursed medical expenses.
ITEM
NUMBER DESCRIPTION VALUE AT DATE
OF DEATH
1 Camp Hill Emergency Physicians - 6-24-2011 services
1,245.00
2 Capital One -credit card account balance
39.94
3 Guardian Long Term Care Pharmacy -prescription services June 28 through July 6, 2011
949.62
4 Harrisburg Pharmacy -prescription services July 2011
37.78
5 Heritage Medical Group -physicians services February 17, 2011
13.36
6 Hospice of Central Pennsylvania -residential care August 1 - 26, 2011
9,630.00
7 Johns Hopkins Hospital -hospital services September 8 and 9, 2010
16,141.34
TOTAL (Also enter on Line 10, Recapitulation) I 28 057.04
(If more space is needed, additional pages of the same size) '
Copyright (c) 2009 form software only The Lackner Group, Inc. Form PA-1500 Schedule 1 (Rev. 12-OS)
REV-1513 EX+ 19-001
SCHEDULE J
COM INHERITANCE~F/~P(RETURNANIA
RESIDENT DECEDENT BENEFICIARIES
ESTATE OF FILE NUMBER
M ers, Pe Y 21-11-0994
NUMBER NAME AND ADDRESS OF RELATIONSHIP TO
DECEDENT SHARE OF ESTATE AMOUNT OF ESTATE
PERSON(S) RECEIVING PROPERTY (Words) ($$$)
I TAXABLE DISTRIBUTIONS [include outright spousal
~ distributions, and transfers
under Sec. 9116 a 1.2
Nicholas Myers Son one-half of
217 Reiley Street personal
Harrisburg, PA 17102 property and
45% share of
Kristen Stoner Daughter one-half of
28 Southmont Drive personal
Enola, PA 17025 property and
45% share of
Total
Enter oll r amo nts for distributions shown bove on lines 15 throu h 18 as a ro riat on Rev 1500 cov er sheet
II NON-TAXABLE DISTRIBUTIONS:
. A. SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAX IS NOT
BEING MADE
B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS
National Ataxia Association is named as a beneficiary as to a 10~
share of the residue of tk~~~estate, however, the probate estate i~ >
is insolvent, there will, therefore, not be any charitable
distribution.
TOTAL OF PART II -ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEETi
Copyright (c) 2002 form software only The Lackner Group, Inc. Form PA-1500 Schedule J (Rev. 6-98)